Mumps is typically a self-limiting viral infection. It was very common prior to the development of the mumps vaccine. With vaccine use, mumps cases dramatically declined.15 However, mumps appears to be making somewhat of a comeback. In recent years, the most common circulating strain of mumps in the U.S. and Canada has been genotype G.1,9 Currently available mump-containing vaccines are manufactured using the genotype A Jeryl-Lynn virus strain. Patients who receive a mumps-containing vaccine develop neutralizing antibodies against the genotype G mumps strain. Antibody titers against genotype G may be lower than those against genotype A.1 Evidence suggests that immunity induced by one mumps virus strain is protective against other strains.9 Over time antibody titers will fall.1 There is not good evidence to reliably link antibody titers with immunity.2 In the U.S., there have been an increasing number of mumps outbreaks since late 2015. In fact there were more than 9,000 mumps cases reported between January 2016 and June 2017.1 The chart below answers questions about mumps vaccination, outbreaks, and management.
Who should receive a mumps-containing vaccine?
Can patients with an egg allergy safely receive a mumps-containing vaccine?
The mumps component of the vaccine is developed in hen and chick embryo cell cultures.2
An egg allergy is NOT a contraindication to receiving MMR.2,3
Skin testing is not required prior to giving a mumps-containing vaccine to patients with an egg allergy.2
Who should NOT receive a mumps-containing vaccine?
The following patients should not receive a mumps-containing vaccine:2
What are the signs and symptoms of mumps?
Many children have no symptoms or only mild symptoms with a mumps infection.8
Common signs and symptoms of the mumps include difficulty chewing and decreased appetite, discomfort and swelling of salivary glands (noted in the front of the neck), feeling tired or fatigued, fever, headache, muscle aches, and parotitis (swelling of the parotid gland, noted on the face in front of the ears).1,8,15
What are the possible complications associated with the mumps?
Complications occur less commonly in patients that have received two doses of a mumps-containing vaccine compared to those who have not had a dose.1
Complications are rare (<1% in recent outbreaks unless otherwise specified), but may include:
Patients with severe symptoms, unable to stay hydrated, or with complications such as encephalitis, meningitis, or pancreatitis may be admitted to the hospital.
How should patients with mumps be managed?
Patients are considered contagious for about one week.11
There is no specific treatment for mumps and management focuses on symptom control.
What are mumps outbreaks?
Mumps outbreaks can occur at any time of year.17
Mumps outbreaks in the U.S. have dramatically increased since late 2015.1,17
An outbreak is defined as three or more cases that are linked by place and time.1
Contact the health department and follow state reporting requirements if you encounter a patient with mumps.16
Outbreaks often occur in close-knit communities or groups with close social, cultural or family ties
Young adults are the most common age group affected by an outbreak.1
Receiving two previous doses of a mumps-containing vaccine may not provide full protection during an outbreak.1
When should a booster dose of a mumps-containing vaccine be given in an outbreak?
Up to three doses of measles, mumps, rubella vaccine appear safe [Evidence Level C].1
A booster dose of a mumps-containing vaccine may provide at least short-term benefit in preventing the mumps.1
During an outbreak, individuals at least 12 months old and identified at risk by the public health authorities that have received one or two doses of a mumps-containing vaccine should get one additional dose (e.g., MMR).1,18-20
Levels of Evidence
In accordance with our goal of providing Evidence-Based information, we are citing the LEVEL OF EVIDENCE for the clinical recommendations we publish.
Good-quality patient-oriented evidence.*
Inconsistent or limited-quality patient-oriented evidence.*
Consensus; usual practice; expert opinion; disease-oriented evidence (e.g., physiologic or surrogate endpoints); case series for studies of diagnosis, treatment, prevention, or screening.
*Outcomes that matter to patients (e.g., morbidity, mortality, symptom improvement, quality of life).
RCT = randomized controlled trial; SR = systematic review [Adapted from Ebell MH, Siwek J, Weiss BD, et al. Strength of Recommendation Taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician 2004;69:548-56. http://www.aafp.org/afp/2004/0201/p548.pdf.]
Project Leader in preparation of this clinical resource (340308): Beth Bryant, Pharm.D., BCPS, Assistant Editor
- CDC. Morbidity and Mortality Weekly Report (MMWR). Recommendations of the Advisory Committee on Immunization Practices for use of a third dose of mumps virus-containing vaccine in persons at increased risk for mumps during an outbreak. January 12, 2018. https://www.cdc.gov/mmwr/volumes/67/wr/mm6701a7.htm. (Accessed February 1, 2018).
- CDC. Morbidity and Mortality Weekly Report. Prevention of measles, rubella, congenital rubella syndrome and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). January 14, 2013. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm. (Accessed February 1, 2018).
- Patja A, Makinen-Kiljunen S, Davidkin I, et al. Allergic reactions to measles-mumps-rubella vaccination. Pediatrics 2001;107:e27.
- Product information for M-M-R II. Merck & Co. Whitehouse Station, NJ 08889. May 2017.
- Product information for ProQuad. Merck & Co. Whitehouse Station, NJ 08889. May 2017.
- Davis NF, McGuire BB, Mahon JA, et al. The increasing incidence of mumps orchitis: a comprehensive review. BJU Int 2010;105:1060-5.
- Johns Hopkins Medicine. Health library: male infertility. https://www.hopkinsmedicine.org/healthlibrary/conditions/mens_health/male_factor_infertility_85,P01484. (Accessed February 1, 2018).
- Johns Hopkins Medicine. Health library: mumps in adults. https://www.hopkinsmedicine.org/healthlibrary/conditions/infectious_diseases/mumps_in_adults_85,P00639. (Accessed February 1, 2018).
- Guidelines for the prevention and control of mumps outbreaks in Canada (archived). June 17, 2009. https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2010-36/guidelines-prevention-control-mumps-outbreaks-canada/epidemiology-mumps.html. (Accessed February 1, 2018).
- CDC. Vaccines and preventable diseases: routine measles, mumps, and rubella vaccination. Updated January 11, 2018. https://www.cdc.gov/vaccines/vpd/mmr/hcp/recommendations.html. (Accessed February 1, 2018).
- Mayo clinic. Mumps. August 12, 2015. https://www.mayoclinic.org/diseases-conditions/mumps/diagnosis-treatment/drc-20375366. (Accessed February 4, 2018).
- NHS choices. Mumps. July 8, 2015. https://www.nhs.uk/conditions/mumps/treatment/. (Accessed February 4, 2018).
- Immunization action coalition. Ask the experts: measles, mumps, and rubella. Updated February 1, 2018. http://www.immunize.org/askexperts/experts_mmr.asp. (Accessed February 4, 2018).
- CDC. Guideline for vaccinating pregnant women. August 2016. https://www.cdc.gov/vaccines/pregnancy/hcp/guidelines.html. (Accessed February 6, 2018).
- HHS. Vaccines.gov. Mumps. January 2018. https://www.vaccines.gov/diseases/mumps/index.html. (Accessed February 6, 2018).
- CDC. Mumps: for healthcare providers. Updated February 2, 2018. https://www.cdc.gov/mumps/hcp.html. (Accessed February 6, 2018).
- CDC. Mumps cases and outbreaks. Updated January 9, 2018. https://www.cdc.gov/mumps/outbreaks.html. (Accessed February 6, 2018).
- CDC. MMWR. Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older – United States, 2018. February 6, 2018. https://www.cdc.gov/mmwr/volumes/67/wr/mm6705e3.htm. (Accessed February 8, 2018).
- CDC. Recommended immunization schedule for adults aged 19 years or older, United States, 2018. Updated February 6, 2018. https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf. (Accessed February 8, 2018).
- CDC. Recommended immunization schedule for children and adolescents aged 18 years or younger, United States, 2018. Updated February 6, 2018. https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf. (Accessed February 8, 2018).
Cite this document as follows: Clinical Resource, Mumps FAQs. Pharmacist’s Letter/Prescriber’s Letter. March 2018.